Naoko Katsurada

Rapidly Progressive Interstitial Lung Disease Associated with Dermatomyositis Treated with Combination of Immunosuppressive Therapy, Direct Hemoperfusion with a Polymyxin B Immobilized Fiber Column and Intravenous Immunoglobulin

Rapidly progressive interstitial lung disease (ILD) is associated with dermatomyositis (DM) and has a high mortality rate even with immunosuppressive agents. For such cases, there is no evidence on the combined effect of direct hemoperfusion with a Polymyxin B immobilized fiber column and intravenous immunoglobulin. We herein report a case of 61-year-old woman who presented with respiratory failure. She showed ILD associated with DM which did not improve with immunosuppressive agents, but was improved with the addition of both direct hemoperfusion with a Polymyxin B immobilized fiber column and intravenous immunoglobulin.

A successful diagnostic case of Pneumocystis pneumonia by the loop-mediated isothermal amplification method in a patient with dermatomyositis

Pneumocystis pneumonia (PCP) can occur in patients with many causes of the immunocompromised state other than human immunodeficiency virus (HIV). It is quite difficult to diagnose PCP without HIV because there is no method for detecting Pneumocystis jirovecii. Thus, non-HIV PCP continues to have high mortality. Recently, loop-mediated isothermal amplification (LAMP) is becoming an established nucleic acid amplification method offering rapid, accurate, and cost-effective diagnosis of infectious diseases. We report a non-HIV PCP case successfully diagnosed by the LAMP method. It was previously reported that PCR in BALF specimens had been the most sensitive method in the diagnosis of PCP without HIV. The LAMP method would be more sensitive than conventional PCR and an effective tool in the early diagnosis of PCP.

Immunogenicity of trivalent influenza vaccine in patients with lung cancer undergoing anticancer chemotherapy

ABSTRACT Lung cancer is a leading cause of cancer-related death, and patients with lung cancer are a priority group for influenza vaccination. However, few studies have assessed the immunogenicity of the influenza vaccine in these patients. Here, we performed a prospective study to evaluate the immunogenicity of the influenza vaccine in patients with lung cancer undergoing anticancer chemotherapy. Twenty-five patients with lung cancer undergoing anticancer chemotherapy and 26 patients with chronic obstructive pulmonary disease (COPD) as controls were enrolled. A trivalent influenza vaccine containing inactivated A/California/7/2009 (H1N1) pdm09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 was administered as a single subcutaneous injection. Serum samples were collected before vaccination, and at 4–6 weeks after vaccination. Levels of serum antibody to hemagglutinin were measured. Among patients with lung cancer, the seroprotection rate (postvaccination titer > 1:40) was 84% for both A(H1N1) and A(H3N2), similar to the levels observed in patients with COPD. However, the seroprotection rate for the B strain was significantly lower in patients with lung cancer than in patients with COPD (64% versus 92%). Even after adjustment for potential confounders, patients with lung cancer had a significantly lower odds ratio for seroprotection against the B strain than patients with COPD. Moreover, in patients with lung cancer, those receiving the platinum doublet treatment tended to exhibit a lower seroprotection rate than those receiving a single agent. Thus, patients with lung cancer undergoing anticancer chemotherapy showed acceptable immune responses to a trivalent influenza vaccine, supporting the recommendation for annual influenza vaccination in these patients.

Effectiveness of inactivated influenza vaccine against laboratory-confirmed influenza pneumonia among adults aged ≥65 years in Japan

Abstract Background The effectiveness of inactivated influenza vaccine (IIV) against laboratory-confirmed influenza pneumonia in older adults remains to be established. Methods Pneumonia patients aged ≥65 years who visited a study hospital in Chiba, Japan, were prospectively enrolled from February 2012 to January 2014. Sputum samples were collected from participants and tested for influenza virus by polymerase chain reaction assays. Influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza pneumonia was estimated by a test-negative design. Results Among a total of 814 pneumonia patients, 42 (5.2%) tested positive for influenza: 40 were positive for influenza A virus, and two were positive for influenza B virus. The IVE against laboratory-confirmed influenza pneumonia was 58.3% (95% confidence interval, 28.8–75.6%). The IVE against influenza pneumonia hospital admission, severe pneumonia, and death was 60.2% (95% CI, 22.8–79.4%), 65.5% (95% CI, 44.3–78.7%), and 71% (95% CI, −62.9% to 94.8%), respectively. In the subgroup analyses, the IVE against influenza pneumonia was higher for patients with immunosuppressive conditions (85.9%; 95% CI, 67.4–93.9%) than for those without (48.7%; 95% CI, 2.7–73%) but did not differ by patients’ statin use status. Conclusion IIV effectively reduces the risk of laboratory-confirmed influenza pneumonia in older adults.

Influenza Vaccine Effectiveness Against Influenza-Associated Pneumonia and Pneumococcal Pneumonia in Older Adults: A Prospective Test-Negative Design Study

Abstract Background Studies have shown that influenza vaccines are effective in preventing influenza-associated acute respiratory illnesses in older adults. However, the influenza vaccine effectiveness (IVE) against influenza-associated pneumonia in this age group has not been established. No study has formally investigated the IVE against pneumococcal pneumonia. Methods This study was conducted as part of a multicenter prospective investigation of adult pneumonia by the Adult Pneumonia Study Group-Japan (APSG-J). All community-onset pneumonia patients aged 65 years or older who visited a community-based hospital in Chiba, central Japan were enrolled to the study from December 2012 to January 2014. Sputum samples were tested for 13 viruses and 6 bacteria by multiplex PCR assays. Patients were diagnosed as influenza-associated pneumonia if sputum PCR assays were positive for influenza A or B. Patients were diagnosed as pneumococcal pneumonia if sputum culture yielded pneumococcus, sputum PCR assays were positive for both ply and lytA genes, or a urinary antigen test showed a positive result. Patients were considered vaccinated if they had received at least one dose of seasonal inactivated influenza vaccine in the 12 months before the hospital visit. A test-negative design was applied to estimate the IVE for influenza-associated pneumonia and pneumococcal pneumonia. IVEs were calculated as (1 – odds ratio) × 100%. Results A total of 1044 patients were enrolled to the study. Among them, 49 (4.7%) were influenza-associated pneumonia, and 168 (16.1%) were pneumococcal pneumonia. The adjusted IVE against influenza-associated pneumonia was 57.2% (95% CI, 17.9% to 76.8%). The adjusted IVE against pneumococcal pneumonia was 31.7% (0.6% to 53.1%); the estimate did not change before and after controlling for pneumococcal vaccination history. Conclusion Influenza vaccines effectively prevent influenza-associated pneumonia in older adults. Influenza vaccines are also associated with decreased risk of pneumococcal pneumonia in this age group, while some residual confounding may remain. Disclosures All authors: No reported disclosures.

Rice-field drowning-associated pneumonia in which pseudomonas spp., aspergillus fumigatus, and cunninghamella sp. Are isolated

We herein report the case of an 84-year-old who developed pneumonia after drowning in a rice field. Besides Aspergillus fumigatus, many pathogens previously not reported in drowning-associated pneumonia (such as Pseudomonas fluorescens, Pseudomonas putida, Nocardia niigatensis, and Cunninghamella sp.) were isolated from his sputum. He received sulbactam/ampicillin, trimethoprim/sulfamethoxazole, voriconazole, levofloxacin and liposomal amphotericin B, but died due to respiratory failure. Because the patient had drowned in a contaminated stagnant rice field and had multiple lung cavities, zygomycosis was suspected. This report provides invaluable information for the consideration of zygomycosis after an individual drowning in a rice field, even in an immunocompetent patient.